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* Germany: In 2005, Germany spent 10.7% of GDP on health care, or US$3,628 per capita. Germany has Europe's oldest universal health care insurance system, with

by mtrn 14y ago

* Germany: In 2005, Germany spent 10.7% of GDP on health care, or US$3,628 per capita. Germany has Europe's oldest universal health care insurance system, with origins dating back to Otto von Bismarck's Social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. * US: According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008. The United States had the fourth highest level of government health care spending per capita ($3,426). Source: * http://en.wikipedia.org/wiki/Healthcare_in_Germany http://en.wikipedia.org/wiki/Healthcare_in_Germany * http://en.wikipedia.org/wiki/Healthcare_in_the_United_States http://en.wikipedia.org/wiki/Healthcare_in_the_United_States

gambiting 14y ago
Yet I am sure that this man would never ever be in a situation like this, had it happened in Germany. I know how it's like in EU - if an operation is life-saving they always do it first,then ask for the money, not the other way around, as it seems to be in the US.
deleted 14y ago
[deleted]
technotony 14y ago
These are old numbers... America is forecast to spend 17 or 18% of GDP on healthcare this year...
- molmalo 14y ago
  Its not about how much money you spend, but how you spend it. USA has made the enourmous mistake of making of health a large business managed by private corporations that dont care about human life. Just money. Other countries see health as a right (luckily thats the case here in Argentina). So, most medics dont get super rich. They work for a salary, they dont get 30 or 50 grand for a surgery. But they still do their job, they work hard and they give their best (well, most of them). Because when you choose that kind of profession, its not for making lots of money, but to help people. Or at least, thats how it should be, and I'm absolutely sure that there are lots of medical doctors there that think this way, but they are just the little fishes inside a pool full with big sharks. I feel sorry for you USA, because you lost it and you wont get it back. There are lots of interests against it. There's not political will, there's not professional will (AMA anyone). Sometimes, from the outside it seems like there's not even a cultural or popular will. A few months ago I discussed this with an American friend and he was totally against universal health care. His argument was something like "why should my taxes pay for some random unemployed or most probably lazy man's health" "if he gets free health care he won't work as hard" "if i make more money why should he have the same benefits as me?" And my answer "because he's a human being too"didn't seem to help. You said it yourself, 17/18 % of the biggest gdp in the world and still cant take care of all of your people. Think about it. Just imagine what you could do with that money in a different system. Seeing this kind of things happening there I can only think about the USA, as a strange place. Home of great technological progress and sad social regress. Dont take it personal.
  - davidhollander 14y ago
    > I feel sorry for you USA, because you lost it and you wont get it back. The position that the USA "lost" the policy of "health as a right" is nonsensical, because it never previously possessed it in its 236 years of existence. You might want to try a different narrative archetype.
csense 14y ago
> Germany has Europe's oldest universal health care insurance system, with origins dating back to Otto von Bismarck... I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable. So what I want to know is, how do they keep it sustainable? For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost? What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale? If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong? How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free? What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?
- _delirium 14y ago
  I'm not sure about Germany, but in Denmark it's just a service of the state. Doctors' salary, and hospitals' equipment needs, are assessed and negotiated the same way as with other sectors of the public-safety apparatus, such as the police department, fire department, and military. You'd like to keep your hospitals well-stocked, your fire engines maintained and modern, your air force state-of-the-art, etc., but without spending infinite money on any of those, so similar decision-making procedures are used for each. Some services are contracted out to the private sector on a competitive-bidding basis. For example, private companies run a number of the ambulance services, and also the Copenhagen bus system: the government draws up its requirements, solicits bids, and chooses a bidder, who then gets an N-year contract. In addition, there are medical-device manufacturers, both foreign and domestic, who sell on the same competitive-bidding basis. So far the bidding seems to be relatively clean, especially compared to, say, what happens with U.S. defense contractors. Moral hazard doesn't seem to be a large problem with hospital services (doctors aren't going to order an unnecessary surgery), and there is a strong culture against unnecessary prescription drugs. So about the worst that can happen is someone wastes their local physician's time 30 minutes at a time. Since small-time office visits aren't where most of the healthcare costs go (in either Denmark or the U.S.), it's a minor concern. As far as foreigners, that's a concern, and handled by the immigration system (you probably won't get a visa if that's the reason you're trying to enter). The main current concern is intra-EU system-shopping of that sort from Europeans, who don't need visas. There are attempts to standardize something around that (the EU "blue card" scheme is one), but it's one of those awkward areas that showcases the EU's quasi-integration. There is also a debate currently about whether Denmark should start charging tourists, since it's one of the few countries that provides completely free emergency care to anyone. Many see this as the right thing to do: if a visitor is injured in a mugging, for example, some people view charging them for the hospital visit as adding insult to injury, like sending them a bill for the police investigation would be. But there is also annoyance that other countries don't reciprocate, so a little bit of a sentiment of, "well if the bastards are going to charge me for getting mugged in NYC, let's charge them when they come here".
unreal37 14y ago
That's TOTAL expenditure (public and private). It's misleading to include private insurance and self payments unless you're talking about the total cost of healthcare.[1] The German government covers 77% of its citizens health care costs. The US government covers 48%. In countries like Germany, I am sure that 77% number is evenly distributed across the population. I.e. All citizens are mostly covered by government insurance. In the US, I am sure the number is disproportional to the elderly and on government assistance, such that people between 20-60 are not covered by any government insurance. So it's a bit more lop-sided than the Wikipedia chart says. [1] http://www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012-frequentlyrequesteddata.htm http://www.oecd.org/health/healthpoliciesanddata/oecdhealthd...
- njs12345 14y ago
  I suspect the 77% is skewed towards the poor - in most European states only the fairly well off would ever go to a private hospital in the first place.
rytis 14y ago
And what exactly the money have been used for? In this case I suspect quantity != quality.

by mtrn 14y ago

gambiting 14y ago

Yet I am sure that this man would never ever be in a situation like this, had it happened in Germany. I know how it's like in EU - if an operation is life-saving they always do it first,then ask for the money, not the other way around, as it seems to be in the US.

deleted 14y ago

[deleted]

technotony 14y ago

These are old numbers... America is forecast to spend 17 or 18% of GDP on healthcare this year...

molmalo 14y ago
Its not about how much money you spend, but how you spend it. USA has made the enourmous mistake of making of health a large business managed by private corporations that dont care about human life. Just money. Other countries see health as a right (luckily thats the case here in Argentina). So, most medics dont get super rich. They work for a salary, they dont get 30 or 50 grand for a surgery. But they still do their job, they work hard and they give their best (well, most of them). Because when you choose that kind of profession, its not for making lots of money, but to help people. Or at least, thats how it should be, and I'm absolutely sure that there are lots of medical doctors there that think this way, but they are just the little fishes inside a pool full with big sharks. I feel sorry for you USA, because you lost it and you wont get it back. There are lots of interests against it. There's not political will, there's not professional will (AMA anyone). Sometimes, from the outside it seems like there's not even a cultural or popular will. A few months ago I discussed this with an American friend and he was totally against universal health care. His argument was something like "why should my taxes pay for some random unemployed or most probably lazy man's health" "if he gets free health care he won't work as hard" "if i make more money why should he have the same benefits as me?" And my answer "because he's a human being too"didn't seem to help. You said it yourself, 17/18 % of the biggest gdp in the world and still cant take care of all of your people. Think about it. Just imagine what you could do with that money in a different system. Seeing this kind of things happening there I can only think about the USA, as a strange place. Home of great technological progress and sad social regress. Dont take it personal.
- davidhollander 14y ago
  > I feel sorry for you USA, because you lost it and you wont get it back. The position that the USA "lost" the policy of "health as a right" is nonsensical, because it never previously possessed it in its 236 years of existence. You might want to try a different narrative archetype.

csense 14y ago

> Germany has Europe's oldest universal health care insurance system, with origins dating back to Otto von Bismarck... I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable. So what I want to know is, how do they keep it sustainable? For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost? What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale? If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong? How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free? What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?

_delirium 14y ago
I'm not sure about Germany, but in Denmark it's just a service of the state. Doctors' salary, and hospitals' equipment needs, are assessed and negotiated the same way as with other sectors of the public-safety apparatus, such as the police department, fire department, and military. You'd like to keep your hospitals well-stocked, your fire engines maintained and modern, your air force state-of-the-art, etc., but without spending infinite money on any of those, so similar decision-making procedures are used for each. Some services are contracted out to the private sector on a competitive-bidding basis. For example, private companies run a number of the ambulance services, and also the Copenhagen bus system: the government draws up its requirements, solicits bids, and chooses a bidder, who then gets an N-year contract. In addition, there are medical-device manufacturers, both foreign and domestic, who sell on the same competitive-bidding basis. So far the bidding seems to be relatively clean, especially compared to, say, what happens with U.S. defense contractors. Moral hazard doesn't seem to be a large problem with hospital services (doctors aren't going to order an unnecessary surgery), and there is a strong culture against unnecessary prescription drugs. So about the worst that can happen is someone wastes their local physician's time 30 minutes at a time. Since small-time office visits aren't where most of the healthcare costs go (in either Denmark or the U.S.), it's a minor concern. As far as foreigners, that's a concern, and handled by the immigration system (you probably won't get a visa if that's the reason you're trying to enter). The main current concern is intra-EU system-shopping of that sort from Europeans, who don't need visas. There are attempts to standardize something around that (the EU "blue card" scheme is one), but it's one of those awkward areas that showcases the EU's quasi-integration. There is also a debate currently about whether Denmark should start charging tourists, since it's one of the few countries that provides completely free emergency care to anyone. Many see this as the right thing to do: if a visitor is injured in a mugging, for example, some people view charging them for the hospital visit as adding insult to injury, like sending them a bill for the police investigation would be. But there is also annoyance that other countries don't reciprocate, so a little bit of a sentiment of, "well if the bastards are going to charge me for getting mugged in NYC, let's charge them when they come here".

unreal37 14y ago

That's TOTAL expenditure (public and private). It's misleading to include private insurance and self payments unless you're talking about the total cost of healthcare.[1] The German government covers 77% of its citizens health care costs. The US government covers 48%. In countries like Germany, I am sure that 77% number is evenly distributed across the population. I.e. All citizens are mostly covered by government insurance. In the US, I am sure the number is disproportional to the elderly and on government assistance, such that people between 20-60 are not covered by any government insurance. So it's a bit more lop-sided than the Wikipedia chart says. [1] http://www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012-frequentlyrequesteddata.htm http://www.oecd.org/health/healthpoliciesanddata/oecdhealthd...

njs12345 14y ago
I suspect the 77% is skewed towards the poor - in most European states only the fairly well off would ever go to a private hospital in the first place.

rytis 14y ago

And what exactly the money have been used for? In this case I suspect quantity != quality.